Thoracic aorta: Traumatic transection

Abstract

Thoracic aortic injury (TAI) is the second most common cause of death in blunt injuries. Most of these injuries occur at the aortic isthmus (ligamentum arteriosum) where the relatively mobile aortic arch can be displaced against the fixed descending aorta during sudden deceleration. With increased utilization of CT-angiogram in surveillance of the traumatically injured patient, as well as improved image resolution, a wide spectrum of traumatic aortic injuries has been identified. Four grades of traumatic aortic injury have been defined; however, not all of these injuries will require emergent treatment. Historically the morbidity of open surgical repair has been significant, particularly in the multiple-injured patient that may have associated brain, pulmonary, abdominal, and/or orthopedic injuries. Thoracic endovascular aortic repair (TEVAR), which has been used to treat degenerative aneurysms, is emerging as a lower-risk and effective way to treat TAI.